Real-time indocyanine green angiography optimises anterolateral thigh flap reconstruction in oral and maxillofacial defects: a prospective clinical study

Zhongming Wu; Weiqi Wang; Yan Wang; Xuejiao Han; Jianhua Wei

doi:10.1016/j.bjoms.2025.06.002

Real-time indocyanine green angiography optimises anterolateral thigh flap reconstruction in oral and maxillofacial defects: a prospective clinical study

Br J Oral Maxillofac Surg. 2025 Jun 23:S0266-4356(25)00145-7. doi: 10.1016/j.bjoms.2025.06.002. Online ahead of print.

Authors

Zhongming Wu¹, Weiqi Wang², Yan Wang², Xuejiao Han², Jianhua Wei³

Affiliations

¹ The Third Affiliated Hospital, Xi'an Medical University, Shanxi, Xian, China; State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Shanxi, Xian, China.
² State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Shanxi, Xian, China.
³ State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Shanxi, Xian, China. Electronic address: weiyoyo@fmmu.edu.cn.

PMID: 40651857
DOI: 10.1016/j.bjoms.2025.06.002

Abstract

This study aimed to evaluate the clinical efficacy of indocyanine green angiography (ICGA) in optimising anterolateral thigh (ALT) flap reconstruction for oral and maxillofacial defects. Fifteen consecutive patients (10 males, mean (SD) age 53.8 (14.5) years) undergoing ALT flap reconstruction following tumour resection were prospectively enrolled. Intravenous indocyanine green (ICG) (2.5 mg/ml) administration combined with hand-held Doppler ultrasound (DUS) enabled preoperative mapping of the descending branch of the lateral circumflex femoral artery and localisation of the perforator. Intraoperative real-time ICGA guidance facilitated precise flap trimming, while postoperative monitoring incorporated both DUS and ICGA assessments. Preoperative imaging revealed comparable perforator detection rates between modalities (DUS: 35/42 confirmed vs ICGA: 33/39 confirmed; accuracy 83.3% vs 84.6%, Z = 0.096, p = 0.081, kappa = 0.82, p = 0.026). ICGA-guided intraoperative modifications proved critical in seven cases, all achieving marginal flap viability. Four high-risk patients avoided reoperation through ICGA-guided perfusion monitoring. Notably, ICGA detected salvageable perfusion in two cases with absent DUS signals, and confirmed arterial patency following re-anastomosis in one case. ICGA enhances surgical precision in ALT flap reconstruction through perfusion mapping, enabling real-time intraoperative decision-making and improved postoperative monitoring sensitivity.

Keywords: Angiography; Anterolateral thigh flap; Indocyanine green; Maxillofacial tumors.